BRAIN MR - PATHOLOGIC CORRELATION WITH GROSS AND HISTOPATHOLOGY .2. HYPERINTENSE WHITE-MATTER FOCI IN THE ELDERLY
BRAIN MR - PATHOLOGIC CORRELATION WITH GROSS AND HISTOPATHOLOGY .2. HYPERINTENSE WHITE-MATTER FOCI IN THE ELDERLY
复制标题
DOI：
10.2214/ajr.151.3.559
复制
发表时间：
1988-09-01
影响因子：
5
通讯作者：
SCHLAEPFER, WW
中科院分区：
文献类型：
--
作者：
BRAFFMAN, BH;ZIMMERMAN, RA;SCHLAEPFER, WW
对死亡时年龄在60岁或以上的23例福尔马林固定的脑标本进行MR检查。其中2例受试者在死亡前也进行了体内MR。在7个脑的长TR MR图像上发现了15个高信号白质病灶。这些病变与大体和显微病理学相关。六个病灶是梗死，两个是小病灶的胶质增生或非空洞性梗死，两个是脱髓鞘斑块，一个是一个小的脑囊肿，一个是先天性侧脑室憩室;在三个病灶的异常是没有发现。我们确定没有MR标准来区分非囊性梗死胶质增生或脱髓鞘。然而，MR能够区分所有三种病变与含液体的空间，包括囊性梗死，脑囊肿，脑室憩室，因为在后一组的病变可能是等信号相对于CSF在体内或液体在蛛网膜下腔在死后固定状态下的所有脉冲序列。脑室憩室和脑囊肿与脑室或蛛网膜下腔的关系是MR的一个额外的鉴别特征。在同时进行CT的病例中，它显示了两个病灶的相应低密度，但未能显示胶质增生（或非空洞性梗死）、脱髓鞘或脑囊肿的病灶。这些数据表明，胶质增生和脱髓鞘的细微变化，可能是慢性血管功能不全，和/或坦率的梗死占大多数高信号白质病变中看到的MR老年患者。区分不同的病变是困难的，但当MR与组织病理学相关时，存在细微的差异。
MR was performed on 23 formalin-fixed brain specimens of patients 60 years old or older at the time of death. In two of these subjects MR had also been performed in vivo prior to death. Fifteen hyperintense white-matter foci were found on long TR MR images in seven brains. These lesions were correlated with gross and microscopic pathology. Six lesions were infarctions, two were small foci of gliosis or noncavitated infarcts, two were plaques of demyelination, one was a minute brain cyst, and one was a congenital diverticulum of the lateral ventricle; in three foci the abnormality was not found. We identified no MR criteria to distinguish noncystic infarction from either gliosis or demyelination. However, MR was able to distinguish all three lesions from fluid-containing spaces.sbd.including cystic infarction, brain cyst, and ventricular diverticulum-since the lesions in the latter group may be isointense relative to CSF in vivo or to fluid in the subarachnoid space in the postmortem fixed state on all pusle sequences. The relationship of a ventricular diverticulum and a brain cyst to the ventricle or subarchnoid space serves as an additional differentiating feature on MR. In cases in which CT was also performed, it revealed corresponding hypodensities in two infractions, but failed to reveal the foci of gliosis (or noncavital infarction), demyelination, or brain cyst. These data suggest that subtle changes of gliosis and demyelination, presumbly from chronic vascular insufficiency, and/or frank infarction account for the majority of hyperintense white-matter lesions seen in MR in elderly patients. Distinguishing among the various lesions is difficult, but subtle differences are present when MR is correlated with histopathology.